Solution Process for Medication Errors in Nursing - Essay Example

? Solution Process for Medication Errors in Nursing Solution Process for Medication Errors in Nursing Medication errors A medication error may be defined as any event that is preventable that may either cause or even lead to inappropriate use of medication or cause harm to the patient whereas control of the medication falls under a health professional, consumer, or patient (Flynn & Liang et al., 2012). Administration of medication to patients is part of the practice of clinical nursing that carries a high-risk rate of errors occurring. These medication errors are caused by factors that are either system based or individual. There are different medication errors such as those related with preparing as well as administering the medication, collaboration between various disciplines, skills of the nurse in calculating doses, orders of oral medication, nursing education, issues pertinent to management of medication (manager nurses as well as changes that occur in the health systems) (Cohen, 2007). In most cases, medication errors are arrested before they get to the patient, or they may reach the patients and cause no harm, or cause treatable as well as permanent harm requiring prolonged hospitalization of the patient. Although there are preventive measures that can be put in place to deter occurrence of these medication errors, they are bound to happen from time to time, and it is expedient for medical practitioners to have necessary skill and knowhow regarding solution to such problems (Wilkinson & Treas, 2011). The reason for taking preventive or curative measures when it comes to nurses’ medication errors are governed by the professional ethics regarding nursing practice. Safety for hospitalized patients and response to or solution of emerging practice errors (such as those of medication) is part of a patient’s rights and should be the topmost priority (professionally) of health practitioners (Flynn & Barker et al., 2002). Problem description Most of the common medication errors arise from insufficient skills of the nurses in administering dosages. One particular medication error occurs in the administration of intravenous medication in the hospitals. Evidence of factors associated with errors in administration of intravenous medication or the severity of the errors is limited, but they do have a notably high frequency of incidence in medical institutions (Wilkinson & Treas, 2011). Intravenous medications are very complex and require many steps in preparing them, administering them, and monitoring the progress of patients under intravenous medication. These processes require precision and particular risks are posed by errors in medication (Cohen, 2007). The medication errors in intravenous medication administration occur in terms of failures in procedures or intravenous clinical errors (Flynn & Liang et al., 2012). Procedural failure includes lack of attention to record administration of medication on a medication chart, administering IV medication at the wrong time, or failing to read the label on medication. Failure by the nurse to wash hands prior to preparing the injection (breaching aseptic techniques), storing intravenous medication temporarily in unsecure environments, or failing to check identification of the patient or blood/pulse pressure prior to dose administration constitute procedural failure (Wilkinson & Treas, 2011). QNSE Competencies A nurse may also fail to check the level of blood sugar before administering insulin or skipping of the procedure of signing register of dangerous drugs by two nurses as required. Clinical errors (intravenous) may be occasioned by incorrect rate of intravenous, which may be faster or slower than recommended, incorrect mixture by using the wrong solvent, using a different volume of solvent in preparation of intravenous medication than what is recommended, as well as incompatibility of drugs by combining drugs that are not compatible through the same intravenous infusion. There may also be errors in general programming of the IV pump (faulty IV valves and pumps). When particularly injecting bolus doses, incorrect rates are a common mistake (Flynn & Liang et al., 2012). These errors in dosage when it comes to administration of intravenous medication may also be occasioned by failure to take into consideration such factors as weight, age, condition of the liver, kidneys, and health conditions or history of the patient. This is especially so when administering extremely sensitive medication such as blood thinners (heparin) or medications for the thyroid glands. The effects of wrong intravenous medication are more serious and manifest faster than for medications taken orally as they are administered in the bloodstream directly (Flynn & Barker et al., 2002). An overdose may result in respiration complications especially in case of a cardio respiratory disease that already exists in the patient. Acute illness, which may be very severe, can also occur. Under dose shows signs and symptoms that characterize insufficient circulation and decrease in perfusion of organs. If wrong type of fluid is administered, changes occur in function and volume of cells that could lead to severe injury to the nerves (Cohen, 2007). Various medications are administered through intravenous injections. Such include insulin, heparin (blood thinner or anticoagulant), vancomycin, sodium chloride solution and thyroidal medications among others. There is a high-risk rate associated with administration of intravenous medication, but if such should occur, there are general as well as specific methods or routes that can be followed to reverse the adverse effects of the medication errors. Some effects of such intravenous medication errors are, however, too detrimental to be reversed or cured and may lead to death of the patient (Brady & Malone et al., 2009). Extravasation, which is a problem, associated with erroneously or accidentally administering IV medications is best solved by way of prevention just like most of the intravenous medication errors (Flynn & Barker et al., 2002). Treatment depends on the medicine that has extravasated and is aimed at minimizing the damage with the worst-case scenario being reconstructive surgery or debridement. Extravasation is managed in steps that include immediate stop of infusion using sterile gloves whereby the infusion lead is replaced with a syringe (disposable) avoiding placing pressure on the area of extravasation. The nurse should aspirate blood back slowly from the arm and take away the intravenous access from the arm very carefully then raise the arm and keep it rested in a raised (elevated) position (Flynn & Liang et al., 2012). Solution Process For an overdose in administering heparin through intravenous injection, it is necessary to put into consideration whether bleeding occurs or not. Where bleeding does not occur, treatment should be stopped immediately, and the patient should be examined to see whether they experience any swelling, dizziness, or running out of breath (Wilkinson & Treas, 2011). Where bleeding occurs, the medical professional should administer an antidote (protamine sulfate). This is administered through an intravenous drip and the dosage should be ten milligrams. The patient should then be monitored for five minutes to establish whether the antidote has combated the effects of heparin overdose (dizziness, bleeding, and swelling) (Brady & Malone et al., 2009). In most cases, wrong administration of intravenous medication occurs in dosage and location of the vein to puncture. If the vein that is punctured is the wrong one, swelling occurs immediately and continued puncturing of the arm in search of a vein brings pain to the patient (Flynn & Barker et al., 2002). When this error occurs, and the patient’s arm becomes sour with pain, the nurse should turn to the other arm, locate the jugular vein, and occlude it just below the intended place for the needle to puncture. The vein will rise and inserting the needle should not be as hard for health worker. The needle is then aligned with the distended vein. This procedure is known as venipuncture and is very important in IV administration. Insulin overdose is treated on the basis of hypoglycemic episodes prevention. This is achieved through continuous infusion of glucose, monitoring capillary glucose in the blood, oral feeding (liberal), and monitoring changes in the electrolyte as well as glargine. A high dose of insulin causes hypoglycemia (Cohen, 2007). Treatment of such intentional overdose of insulin can only be done by the patient seizure in partaking any more insulin and waiting for the effect to clear (Flynn & Barker et al., 2002). The best practice for solving the problems occasioned by intravenous medication errors is by prevention and taking necessary precautionary measures. The best practices that can be used in ensuring safety in administration of intravenous medication include establishment of comprehensive standard procedures for administration, preparation as well as ordering intravenous medication (Wilkinson & Treas, 2011). Such doses could also be measured already and ready to be administered as much as possible. The intravenous medications that are most likely to result in harm, in case of occurrence of error, should be standardized throughout the world for every patient (including the ones who are extremely vulnerable-newborn babies and the elderly, as well as the ones with chronic conditions medically. Use of intelligent intravenous pumps that have safety features which help in prevention of harmful doses and rates. This presents the hospital management with the business case for intravenous injection safety (Flynn & Liang et al., 2012). Long term measures that can be taken include, provision of resources and tools in order to facilitate adoption of intravenous injection safety practices, development of a framework for research in the future on intravenous medication safety (Wilkinson & Treas, 2011). Others are establishment of multidisciplinary safety training on medication for professionals in the healthcare, use of standard bar codes, which are easy to read in order to verify intravenous doses and drugs. There should also be provision of resources and tools that will facilitate the adoption of safety practices in intravenous medication (Brady & Malone et al., 2009). Nurses ideas should be incorporated in the management decisions and this will ensure that they feel part of the process and hence dedicate their energies towards the successful implementation of the various patient related programs. The final approach used is through management of expectations, which are the formation of the patients informed by the attention and information at their disposal. Delays and unprecedented eventualities should be communicated to the patients apologetically to mitigate any negative perceptions the patients might develop (Wilkinson & Treas, 2011). Others are establishment of multidisciplinary safety training on medication for professionals in the healthcare, use of standard bar codes, which are easy to read in order to verify intravenous doses and drugs. There should also be provision of resources and tools that will facilitate the adoption of safety practices in intravenous medication (Brady & Malone et al., 2009). Conclusion In conclusion, errors in administration of medication are more frequent in occurrence and are deadlier than all other errors in medication. These errors have a negative impact on both the patients and nurses. Outcomes of small proportions of errors in administration of IV medication may be very serious and detrimental. These errors as we have seen are suggestive of deficiency in knowledge and skills of the medical practitioner. The more the experience of the clinical officer, the less severe the effects of errors or omissions made. By understanding the nature of intravenous related errors in medication, then patient care can be improved. It is good to note that intravenous medication is used to save lives of many people but if wrongly administered, is fatal and can result in death. References Brady, A., Malone, A., Fleming, S. and Ra (2009). A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of nursing management, 17 (6), pp. 679—697 Cohen, M. (2007). Medication errors. Washington, D.C.: American Pharmacists Association Flynn, E., Barker, K., Pepper, G., Bates, D. and Mikeal, R. (2002). Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities. American Journal of Health-System Pharmacy, 59 (5), pp. 436—446 Flynn, L., Liang, Y., Dickson, G., Xie, M. and Suh, D. (2012). Nurses’ practice environments, error interception practices, and inpatient medication errors. Journal of Nursing Scholarship, 44 (2), pp. 180—186 Wilkinson, J. and Treas, L. (2011). Fundamentals of nursing. Philadelphia: F.A. Davis Co. Read More